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April 20, 2007

The Milwaukee Protocol

I had 90 minutes to kill at the US Embassy yesterday. Between meetings, type of thing.
So after I grabbed some lunch -- the Embassy has a rather decent little cafeteria -- I parked myself in the little library with my laptop. The library is all reference books and magazines, and seems to be mostly used for language lessons. Still, it was a place to be.
After an hour or so, I decided to give myself a short break. Strolled over and browsed the magazine section. National Geographic, no. Time, definitely no. The Economist, would take too long. Scientific American... sure, okay.
And that's how I found out about the Milwaukee Protocol.

Rabies is really scary. You can get it from even small bites or scratches, and if you don't start treatment before symptoms appear, you die. Period, full stop. The only treatment at that point is to alleviate your symptoms, i.e. make dying easier. Decades of determined effort have made rabies rare in the US, but it's still horribly common in the rest of the world, with tens of thousands of people dying every year.
Except.
I didn't know it until yesterday, but since 2005 there has been one (1) unvaccinated survivor of full-onset rabies. She's walking around today. She's fine. She's from Fond du Lac, Wisconsin. Her name is Jeanna Giese.
(There have been some other rabies survivors -- wikipedia says six, another article says two -- but they all got vaccines first. And most of them seem to have ended up with lasting damage.)
So how'd she survive? Well, her doctor made some assumptions.
(1) Rabies doesn't necessarily destroy your brain and nervous system; it just messes it up for a while. In medical-speak, "Death is primarily attributable to reversible dysfunction rather than irreversible destruction of brain, spinal cord and nerves." The infected brain sends mad signals to the heart, lungs, and muscles, leading
(2) The rabies virus is eminently killable; the body's own immune response can deal with it, given time. (The key fact here was that autopsies of dead rabies victims sometimes showed quite low levels of the virus.) Also, rabies antiodies can be injected to accelerate the process.
I'm going to oversimplify some way complicated medical thinking and say, the doctor looked at these assumptions and said, let's put her into a coma. An induced one, with drugs. His thinking was, shut down the infected brain and keep it from damaging the body, thus giving the immune system time to go after the virus.
It worked. She was in a coma for over a month, and in pretty awful shape when she got out of it. But she slowly recovered, and today she's completely fine. She has a numb spot on one finger and a couple of minor neurological issues, but she's going to college.
Now, before we get too enthusiastic, let's note that nobody has been able to duplicate this success. There have been several attempts, and they've failed. The patients have died. There is reasonable and skeptical debate over whether the coma was really necessary.
So it's not yet clear whether this treatment -- the "Milwaukee Protocol" -- really works. Maybe the bat gave her an unusually weak strain of rabies. Maybe Ms. Giese had an unusually strong immune system.
Still... what a story.
Full medical description of the Protocol, if you're interested (.pdf).
(Coming soon: that Chinese map again, and more on the Persian Embassy.)

Comments

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See, I should turn this into a Wisconsin blog. Except then you'd also be reading about the guy who ran over the mutant deer in his driveway and ate it, and those three guys and the graveyard (and you really don't want to know more), and so on.

When I get back to cleaning my sock drawer, you'll see that I looked at a number of papers regarding Ms. Giese's treatment, past rabies treatments, and the known information on the mode of action of the rabies virus, which is not very much at all.

A slight tangent. The Milwaukee Public Museum's old bat expert, Merlin Tuttle, has always promoted bat conservation: trying to stop idiots from throwing dynamite into caves to kill the rabid bloodsuckers, that sort of thing. Most bats don't carry rabies; you can tell this because most bats are alive, and not acting like a crack fiend. (And most bats don't suck blood.)

However, the rabies virus changes and spreads like any other disease, and it has been spreading in other animal populations in the US, most notably in skunks and raccoons.

However however, rabies is still an extremely rare disease in the US. A sense of perspective is necessary. There's never going to be a Milwaukee Protocol for a bus going off an overpass.

God, the horror is immense. When I was around 14 and living in Kinshasa, Zaire, our small dog was bitten by strays and got rabies. It was an incredibly gruesome thing to witness. I just wish that someone could perfect the treatment and be able to cure someone already infected.

God, the horror is immense. When I was around 14 and living in Kinshasa, Zaire, our small dog was bitten by strays and got rabies. It was an incredibly gruesome thing to witness. I just wish that someone could perfect the treatment and be able to cure someone already infected.